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I GONCALVES & TORTOLA S/A
EST MARINGA, O- LOTE 152
3 Page A
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GLEBA PATRIMONIAL MARINGA
MARINGA/PFYBRAZIL ON BEHALF OF
1t1 Resistry Number EGP0M2-22
C 5 llems 6 Tot Pack | 7 Refertr@ Number
NORWEST FOODS INTERNATIONAL
1 18oo I relozoazeor
Itmporter/Consigne,Add@ss TIN: 008606050000 9 CRF NUMBER:

U FABROSSI FOOD GROUP INC.

V AND F ICE PLANT COLD STOMGE INC T/S or W/S Entry No. :
UNIT 5 BRGY MAMBUGAN ANTIPOLO CITY
ANTIPOLO 1870
s PHILIPPINES 10 11 12 Tot. F/l/O (PhD)
213,390.48
I '3 T. Ref.
I

14Brcker/Attmey-.lrFacl,Addre$ TIN: 746897860000 15 CountryofExporl 15 C.E, Code 17

T KATRINA PAz SUAREZ

SITIO PUNOT, BRGY. SAN ROQUE GAPAN
BRAZIL BR PH

CITY NUEVA ECIJA 16 CountryofOrigin 17 Country of Deslination

o GAPAN 3105
PHILIPPINES BRMIL PHILIPPINES
Vesel,/AircEfl
18 lts ct 20 Tems of Delivery

M cMA ccM RoDoLPHE lecpooaz-zzl ,/ crF

21 Lmal Carier (if any) 22 F.Cut Total Customs Value I 23 Exch Rate I 24 Thru Bank

25 26 27 Transhipment Port
usD2o,25o.oolso.ooalzlx
S 8t30t2022 28 Financial and Bar*ing Data - Bank Code 998
Tms Paymflt
of 01 - BaSic
29 Port of Destination 30 Lmation of Goods BankName PCHC
1 PO2A
Bmnch
Port of MEnila s01 NA BankRefNmber: 010410017-9054261

31 Packages MarksandNumbe6-ContainerNo(s) 132 lteml'lo. 33 HS Code Sp6 Code

and
Marks & No AS ADDRESS | 1 02071491 000 000073
Description
of Packages
of Goods
NumberandKind 1800 BX BOX BR Itt za.og2-qzl Non"
Conhine.No(s) EMCUSS29709 P@dure (kg)
37 | 38 ltem Net Weighl | 39 Qouta
- - - - Mechanically deboned or separated meat
Frozen Chicken Mdm/Msm (Goncalves & Tortola Brand) aooo orut I zz.ooo.oo I ruruuur.r
1X4O CONTAINER STC FROZEN MECHANICALLY DEBONED POULTRY MEAT 4oa AwB/BL l4ob P*ri"r"Dffi
MDM EGLV36o2ooo793o5 I

4'1 Suppl. Units 42 ltem Customs Value (F. 43 V.M.

20,zfi.OO NV
OTHinEV: 1 INS|nFRT: 0 Fih6 l

D@ / Prcduct Code 5 Adjustment

Ceruf- & 16A,024.00 +45,366.48 +0.00 +872.54 -11,066.72
Aut 't.00
A"O.

MSP 46 Dutiable Valua (PHP)

0.00 1,317,552.48
lnvoi@ No. ; 612462 Dump Bond i

47 TyF Tax Base 4E Prepaid AccNni N- 49 ldentificafion of Warehouse

of Taxes |
ll
cuD 1,347,552.48 5% 67,377.62 0
7b ACCOUNTI\ G DETAILS
vAT 1,434,966.40 't20k 0.00 0
Method oi Pay, ent : CASH
0.00
Asse$menl Nu nber : Date :

Rrciept Numbet : Date :

Guahntee 0.00 Date i

Total Fee 1,840.00
rotal rtm: 67,377 .62 Total Assesme nr 69,217.62

50 We hereby @rtily that the inFomation mntained in all pages Subscribed and sworn trcfore me
of this Declaration and the d@uments submitted are to the best
o, our knowledge and belief fue and @ffmt

51 AUTHG Arr'( J. BOLJVAF

RIZATION
SUAREZ
JBL9J lto.:lUllffi lAZi
FtH0.I llr.0t!!trtD 0i
llFl I lll Xl:trrroi,o, !.rrn r
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52 Control Cod6 53 onEe orD.diilqflfm*fiffiar4 *,
al Omce oestinafion -!-l* .!!
CONTROL AT OFFICE OF DESTINATION Stamp 54 Pra@andqtlBK
Signature - sgii,r+..s ir
---\
53 TNTERNAL REVENUE (TAX PER BOX #45 e#471

TAXABLE VALUE PH 1,347,552.48 ryHARFAGE 872.54 oTHERS 1,000.00

BANK CHARGES 0.00 TOTAL 1,434,883.80

ARRASTRE CHARGE 11,066.72
CUSTOMS DUTY e7377.62 LANDED COST PH x lZok
BROKERAGE FEE 6,734.M DOCUMENTARY STAMP TOTAL VAT PH

DESCRIPTiON IN TARIFF TERMS SHOULD BE

54 SECTION 55 NO. OF PACKAGES EXAMINED 56 DATE RECIEVED 57 DAIE RELEASEO

EXAMINATION RETURN

58
ITEM TARIFF
NO DESCRIPTION IN TARIFF TERMS SHOULD BE OTY UNIT UNIT VALUE HEADING RATE

PLEASE REFER TO RIDERS FOR FINDINGS ON OTHER ITEMS

REVISED CHARGES LIQUIDATION

53 CHARGES 60 DECLARATION 61 FINDINIGS 62 DIFFERENCES 65 LIQUIDATED Amount

Duty
BIR Taxes 66 SHORT/EXCESS
VAT
Excis TarAd Valorem 67 REMARKS
Others
Surcharges
TOTAL
64 68

DATE COO III DATE

6g

DATE COO V DATE

CONTINUATION FROM BOX # 31 FREE DISPOSAI- CUD 57,377.62

Container Numbers Gontinuation:
VAT 0.00

Tolal ltem Tax

IPF

GSF 560.00
CDS 250.00
IRS 30.00